Thursday, September 16, 2010

Here We Go Again

As everyone is aware, the vet was out this morning to vaccinate and check up on Lilly's tendon. I'll start with AJ since his is an easier story to tell.

Dr Elaine's first comment was, "he's skinny!" She said she thinks he needs to gain about 50 pounds, but looks healthy otherwise. His teeth look great, so she doesn't see any reason why he shouldn't be gaining weight other than he isn't getting enough food. She thinks he should be getting about 6 pounds of feed per day in order to put that weight back on in 30 days-ish. Right now he's only getting 2 pounds, and that's assuming he's getting it all (which we know he's not thanks to Lilly).

As usual, he was super good about his shots... I always say if he had thumbs he'd vaccinate himself. :) She checked his cataract and said it still looks small and there aren't any more, so he's good to go.

I later spoke to the BO about the grain increase and he seemed annoyed by my request. He bases the board cost on a specific level of feed, so by feeding 6 pounds per day, I guess he thinks he'll be losing money. So I told him I'd buy the feed myself or pay him more for AJ's board. I don't really care if I have to pay more, I just want him to get more feed. He's going to let me know later what he wants to do.

Now on to Lilly.

She got her vaccines and her coggins done and we moved on to her tendon. Right away Dr Elaine noticed she was standing with her left front foot slightly forward. Lilly stands like that a lot, I think to take some of the weight off her leg. She kept having Lilly stand square, and right on cue, Lilly would put it back out front.

She palpated the tendon and Lilly seemed a little tender, but not much. She wanted to watch her move, so we took her up to the arena and had her trot on the longe line. She was a bit more lame than yesterday and Dr Elaine put her at a 3/5. We did a flexion test and Lilly trotted off pretty lame, so we took her back to the barn to do an ultrasound.

Dr Elaine scanned her leg for a LONG time... she even did the other leg to compare but couldn't find any lesions or tears. She said the DDFT actually looked really good and had healed nicely, but her check ligament was "really ugly".

You may or may not recall me mentioning the check when my other vet came out to do the ultrasound in August. She said the check looked ugly but we both kind of brushed it off since she had the ICL surgery when she was a baby and we were focusing on the DDFT.

For my own understanding, and to give you a little more information about the relationship between the DDFT and the ICL, here's a good description I found from the Atlanta Equine Clinic describing that relationship:

The distal accessory or “check” ligament is an extension of the palmar carpal ligament that joins the DDF tendon at the level of the mid cannon bone. By restricting excessive movement of the DDF tendon through it attachments, the distal accessory ligament functions to keep the DDF tendon in “check”. If excessive DDF tendon tension persists by the time the horse reaches 8-10 months of age, then surgical intervention in the form of distal accessory (check) desmotomy is often elected. Cutting the check ligament physically releases tension on the DDF tendon, allowing it to “lengthen”.

And that's what we did with Lilly when she was 6 months old. I understand the logic behind the ICL surgery, but I guess I didn't think the ICL would still be in play now. I thought it was cut... that's it... out of the picture. Not the case, however. Dr Elaine said those tendons eventually grow back, but will grow back longer than they were previously because now the dynamics of the leg/hoof have changed. However, like with the DDFT, the tendons just aren't as strong or stretchy since they're full of scar tissue.

After printing off some pictures from the ultrasound machine, Dr Elaine wanted to nerve block Lilly's hoof just to make sure we weren't dealing with something other than the tendon. After giving the block some time to work, we took her back to the arena to longe her. She was worse, so it is most likely her ICL.

So what's the diagnosis?

We think during the time Lilly was walking around on 3 legs because of her abscess, she was (obviously) putting a lot of strain on her left leg. The ICL most likely took the brunt of that strain because of what her DDFT had already been through. She didn't show any lameness before because she was already on stall rest and I wasn't riding due to the myriad of other problems we faced during the month of August. Once she was cleared for turnout and riding, the already stressed tendon was strained more, to the point where it started causing her pain.

So what's the plan?

Just to make sure, Dr Elaine is going to compare today's ultrasounds with past ultrasounds and see if she can find the pictures my other vet took of her tendon in August. I'm not sure she took any pictures, but if they're there, she'll find them. Once she makes the comparison (and likely concluded we have a check ligament problem) she'll call me with a more detailed plan.

For now, she had me turn her back out and wants me to use the Surpass cream. The look of horror on my face must have told the story about how I feel about Surpass because she said, "are you scared to use it?" Umm... well, I'm a little cautious, I must confess. I do think the issue was most likely from the leg wrap, so I'll give it another try without a bandage this time and closely monitor her skin.

Should she conclude it is the ICL, the plan will change to 3-6 months of stall rest and possible shock wave therapy. There's no lesion or tear to inject, so the shock wave would be the best course of action.

Another tendon rehab coming my way. Here's where the frustrated me starts to take over.

No State Fair... no riding for probably 6 months... no more shows until who knows when... hand walking every day... and another small fortune on rehab.

At what point do you say enough is enough? Is spending another $1000 on one of Lilly's other tendons going to make a difference in the long run?

I knew her DDFT would be compromised for the rest of her life, but I didn't think that the other tendons in her leg would be at risk. I'm not sure why I thought that, but I did. I thought if anything was injured, it would be the DDFT again. So when does her SDFT become compromised, if it isn't already? Will that leg ever be 'normal' again and will we continue to battle soundness issues?

I am past the point of frustrated. I'm sad, I'm angry, I'm heartbroken... I've been on the verge of tears all day. No way would I ever give up on Lilly, but maybe it's time to give up on showing for a while. This past year has been such an emotional roller coaster for me. Just when things start to get back on track, we go flying off course. I get my hopes up, I get excited, and then it all comes crashing down around me.

I'm getting tired of being positive all the time because it gets me nothing but grief. At least if I expected the worst and anticipated the worst, I wouldn't be disappointed when the worst thing that can happen does happen.

On top of that, she needs her teeth floated because she has hooks and ulcers. She was just floated last fall and checked this spring for crying out loud... we didn't have time to do it today but Dr Elaine said, "don't worry... sounds like I'll be out plenty of times so we can do it then to save you an extra farm call."

Please send well wishes Lilly's way. My sweet mare has gone through more than any horse should ever have to.

I'm so sorry that this is happening to Lilly--and you too.I know they turn horses out for tendon issues... do you think maybe this would be a good plan of action? I almost feel like if you stalled her again for x amount of time, it's only going to make the tendons and ligaments weaker. I'm certainly no vet, but it will be easier on your wallet, your time--and maybe, on her poor legs.I think Dawn's (from the eventing percheron) TB mare was turned out for a bad bad tendon problem when she was told to put the mare down. Mare recovered 100%. I could be off on the details... but it is not unheard of, just not common in our world where spent money = love.

Just something to think about. I wish you two the best of luck, and will be reading every step of the way, even if I don't have time to post.

I am so sorry - I know exactly how you feel from dealing with Maisie's repeated tendon/ligament problems. The good news is that it sounds like the vet thinks there is a road to recovery for her, even though it'll be long and hard for you. My best wishes to you and your sweet Lilly.

I am so so so sorry about all of this. Lily is so lucky to have such a caring mom in you! I truly hope and pray that by next summer, you'll be back to the show ring on your sweet mare and all of these troubles will be behind you both. Go ahead and get angry, be upset, be negative. When you're done, get your chin back up and put those positive thoughts back in your head...it will get better! In the meantime, you have your blogging buddies to hear you out regardless of whether it's good or bad!

Im so sorry to hear about the latest with Lilly. She will be in my thoughts and prayers. It is so frustrating to NOT know what is going on and when you think something is fixed, something else happens.Im glad to hear that you arent giving up tho, and I know how are it can be to stay positive. :(